Kraft Foods Group, Inc. Retiree Medical and Prescription Plan Summary High Deductible Health Plan

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1 General Provisions Deductible (eligible medical and prescription drug expenses apply to the deductible) Kraft Foods Group, Inc. Retiree Medical and Prescription Plan Summary Care can be obtained in-network or out-of-network without a referral. To receive the highest level of benefits, please verify physician network participation. Out-of-network and Out-of-area benefits are subject to reasonable and customary charges. You pay the out-ofnetwork deductible and coinsurance, plus any charges in excess of reasonable and customary amounts. Amounts over reasonable and customary do not apply to the plan's out of pocket maximum. $1,500 for employee-only coverage; $3,000 if you cover at least one other person $3,000 for employee-only coverage; $6,000 if you cover at least one other person Coinsurance 80% 60% Annual Out-of-Pocket Maximum $3,400 for employee-only coverage; $6,800 if you cover at least one other person $6,800 for employee-only coverage; $13,600 if you cover at least one other person Lifetime Maximum Benefit $2,000,000 Precertification of Care is required within 48 hours of an emergency hospitalization, before admission to any facility, Precertification and for certain outpatient services. A $300 penalty will apply for not pre-certifying as required and room and board will not be reimbursed for admission exceeding the approved length of stay. Inpatient Hospital Services/Office Visits Inpatient Hospital Services Including Physician Charges Maternity Care Including Delivery Office Visit for Illness or Injury Office Visit/Preventive Care (Preventive Care, Well-Baby Care, Well-child(ren) Care, Well-woman Care, Physical exams, Vision exams) 100% coverage with no deductible 100% coverage with no deductible up to $1,000 annual maximum per person (well-child max is $1,500 for the first 12 months and $1,000 thereafter); (vision exams are limited to 1 annual exam per year); thereafter, subject to the deductible and coverage at 60% Ambulatory Services Emergency Room/ Urgent Care Center 80% coverage after deductible for approved emergencies; 60% coverage after deductible for non-approved emergencies 80% coverage after deductible for approved emergencies; 60% coverage after deductible for non-approved emergencies EFF01/01/2014-PD01/16/ HDH1/HDH2

2 Outpatient Surgery in Licensed Ambulatory Surgical Centers Physician Office Surgical Procedures Diagnostic Testing (not billed as preventive care) Chemotherapy/ Radiation Therapy Mental Health/ Substance Abuse Inpatient/Intermediate Care/Partial Hospital/Residential Treatment Outpatient Office Visit for Individual or Group Counseling or Therapy Other Services Skilled Nursing Facility Hospice Home Health Care & Private Duty Nursing Ambulance Therapies Physical / Speech / Occupational Kraft Foods Group, Inc. Retiree Medical and Prescription Plan Summary 80% coverage after deductible; including PAP smears, mammograms, PSAs, digital rectal exams (DRE) and cholesterol screenings/lipid panels 60% coverage after deductible; including, PAP smears, mammograms, PSAs, digital rectal exams (DRE) and cholesterol screenings/lipid panels 80% coverage after deductible (pre-certification required for inpatient care and certain outpatient procedures) 80% coverage after deductible (pre-certification required for inpatient care and certain outpatient procedures) 80% coverage after deductible (120 days per year combined maximum 80% coverage after deductible (up to 2 successive six month treatments combined) 60% coverage after deductible (pre-certification required for inpatient care and certain outpatient procedures) 60% coverage after deductible (pre-certification required for inpatient care and certain outpatient procedures) 60% coverage after deductible (120 days per year combined maximum) 60% coverage after deductible (up to 2 successive six month treatments combined) up to 15 visits per year 80% coverage after deductible for approved emergencies; 60% coverage after deductible for non- approved emergencies 80% coverage after deductible; annual maximum 60 combined visits for Physical Therapy and Occupational Therapy, and 20 visits for Speech Therapy (medically necessary). 60% coverage after deductible; annual maximum 60 combined visits for Physical Therapy and Occupational Therapy, and 20 visits for Speech Therapy (medically necessary). Durable Medical Equipment 80% after deductible 60% after deductible EFF01/01/2014-PD01/16/ HDH1/HDH2

3 Retiree Medical and Prescription Plan Summary Alternative Care - Chiropractic and Acupuncture Services $2,500 annual maximum; Chiropractic and Acupuncture services are combined Domestic Partner / Adult Child Coverage Vision Discount Program Either a domestic partner or adult dependent child may be covered If you are an Aetna Medical or Dental Plan participant, the Aetna Vision Discount program may be used for routine exams, hardware (e.g., lenses and frames) and laser surgery at the time of purchase or service. Please contact Aetna to receive a list of participating providers. To receive the discount, present your medical or dental ID card to the participating provider. Exclusions Not every medical service or supply is covered by the plan, even if prescribed, recommended, or approved by your physician or dentist. The plan covers only those services and supplies that are medically necessary and included in the benefits summary and/or the Retiree Medical Plan Supplemental Summary Plan Description. The Retiree Medical Plan Supplemental Summary Plan Description contains the list of applicable exclusions, conditions and limitations. Coordination of Benefits Maintenance of Benefits Method your coverage under the Retiree Medical Plan uses the Maintenance of Benefits Method ( MOB ) of coordination with Medicare. Please see the Retiree Supplemental Summary Plan Description for more information. Medicare Important Note About Medicare Enrollment Medicare is a federal program available to individuals at age 65 or after two years of receiving Social Security disability benefits. Medicare is the primary plan/coverage for you and your covered dependents that are eligible for Medicare due to age or disability. When eligible for Medicare, you and/or your covered dependent must enroll in Medicare Parts A and B and notify the Kraft Foods Benefits Center by calling Medicare enrollment does impact your premiums and claim payments. If you are eligible for Medicare and do not enroll in Medicare Parts A and B or if you see a physician who does not accept Medicare or has opted out of Medicare, your Plan benefits will still be calculated as if you were covered by Medicare. PLEASE NOTE: You or any of your covered dependents will not be eligible to participate in the Kraft Foods sponsored Retiree Medical Plan if you or your dependents elect the optional prescription drug coverage under the Medicare Modernization Act of 2003 (Medicare Part D). In general, the prescription benefit provided in the Kraft Foods Retiree Medical Plan is at least as good as or better than the standard Medicare D sponsored benefits. EFF01/01/2014-PD01/16/ HDH1/HDH2

4 Retiree Medical and Prescription Plan Summary Health Savings Account A health savings account is a separate trusteed account maintained at a bank that you own and maintain at all times. There are many potential tax advantages to an HSA: You can elect to contribute before-tax dollars up to annual limits. As contributions limits may change year to year, you should verify with the Internal Revenue Service (IRS) what the current annual limit is. If you will be 55 or older during the year, you may be able to make catch up contributions in addition to the otherwise applicable contribution limit for that year. This information can be obtained by contacting the Internal Revenue Service (IRS). Your account can be invested in the investment options available to you under the health savings account and earnings are tax free. Distributions are tax free if they are used for qualified medical expenses There is a 20% penalty in addition to other applicable taxes-- for distributions you take before age 65 that are not for qualified medical expenses. (The 20% penalty does not apply if you are enrolled in Medicare or are deemed to be disabled.) At age 65, you can use your account for non-qualified medical expenses without the imposition of the 20% penalty tax. If you die before you have depleted your account, there is no tax on the transfer to your surviving spouse. Qualified medical expenses include any expense incurred for medical care as defined under section 213(d) of the Internal Revenue Code. (See IRS Publication 502 available at for more information.) You can use your account to pay COBRA premiums and your post-age 65 Medicareand retiree medical coverage as long as the coverage is not a Medigap or Medicare Supplement plan. You cannot, however, use it to pay for over the counter medicines unless prescribed by a physician. Unlike a health spending account, there is no use it or lose it forfeiture rule. You own your account and it is completely portable meaning that you can transfer it to another health savings account vendor. Note: In order to be eligible to contribute to a health savings account for tax law purposes, you have to satisfy several standards including: You must have no other health coverage that is not qualified as a high deductible health plan. Further, your spouse must not maintain a health care spending account or health reimbursement account under which your medical expenses may be reimbursed (There are exceptions for limited purpose FSAs or HRAs which only provide reimbursement for dental or vision care.) You must not be eligible for Medicare or enrolled in Tricare. You may not be claimed as a dependent on someone else s tax return. You must maintain your coverage under a high deductible health plan for 12 months for you to avoid having to pay an excise tax of 6% on overcontributions. You are responsible for keeping sufficient records to demonstrate compliance with HSA tax requirements and for filing required tax forms. Important Note: You are solely responsible for determining whether a health savings account and its available investments and fees are right for you. You are fully responsible for preparing and submitting an IRS Form 8889 if you are claiming a tax deduction for a contribution to your health savings account, or are reporting a distribution or excise tax relating to your health savings account. Customer Service Telephone Number Aetna EFF01/01/2014-PD01/16/ HDH1/HDH2

5 Retiree Medical and Prescription Plan Summary General Provisions Deductible Preventive Drugs and Value Generics Prescription Drug Coverage Prescription Drug benefits provided through Aetna. A separate I.D. card must be utilized for these services. Aetna Customer Service: Please Note: For maintenance or preventive drugs after first three fills, no benefit will be provided unless ordered via mail order or obtained at a CVS pharmacy. There is no coordination of benefits for prescription drug benefits. You may choose what benefit plan to use, but you will not be reimbursed any out-of-pocket expenses for prescription drug claims incurred other than under the Medical Plan If you do not use an Aetna retail network pharmacy to obtain a Value Generic drug, no benefit is payable under the plan for that prescription. You always pay the lower of the actual cost or the participant cost under the plan. Lifetime Maximum for infertility drugs: $15,000 (amounts previously paid under a Kraft Foods or Nabisco medical plan apply to the lifetime maximum). No separate calendar year deductible for prescription drug coverage; All eligible medical and prescription drug expenses apply toward the in-network, calendar year deductible. No Deductible EFF01/01/2014-PD01/16/ HDH1/HDH2

6 Retiree Medical and Prescription Plan Summary Prescription Drug Coverage CO-PAYS AND CO-INSURANCE TIER 1: GENERICS Retail: $7.50 co-pay, after deductible Mail: $15.00 co-pay, after deductible TIER 2: PREFERRED BRAND DRUGS Retail: 30% co-insurance ($20 min/$50 max), after deductible Mail: 25% co-insurance ($40 min/$100 max), after deductible TIER 3: NON-PREFERRED BRAND DRUGS Retail: 45% co-insurance ($35 min/$65 max), after deductible Mail: 40% co-insurance ($70 min/$130 max), after deductible Choosing Brand over Generic: If a generic is available, and you choose to get the brand instead, you will pay more. You ll pay the difference in cost between the brand and generic, plus the applicable copay for your plan. You may receive one initial prescription fill, plus two refills of a maintenance (or long-term) medication at a Use Aetna Mail Service or CVS participating pharmacy. After the third fill, a 90-day prescription is required for future maintenance medications and Pharmacy to Fill Your Long- must be filled through Aetna Mail Service or at a CVS pharmacy to receive benefits. After the third 30 day refill of a Term Medications: maintenance medication, if the prescription is not filled through Aetna Mail Service or a CVS pharmacy with a 90-day prescription, you will pay the full cost of the prescription. Specialty Drugs If you have been prescribed a specialty drug, contact Aetna Specialty Pharmacy at There is no separate prescription drug out-of-pocket maximum. Eligible prescription drug and medical expenses apply to the Medical Plan s calendar year out-of-pocket maximum. Once you have satisfied the applicable deductible Maximum Out-of-Pocket for the calendar year, you continue to pay your out-of-pocket costs for covered drugs until you reach the in-network out-of-pocket maximum for the calendar year. After that point, you have no additional out-of-pocket costs for covered drugs. This is intended as a brief summary of benefits for comparison purposes. The Contracts and Master Plan Document govern in all cases. Not all covered services, exclusions and limitations are shown here. EFF01/01/2014-PD01/16/ HDH1/HDH2

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